Table 5 Themes, subthemes and illustrative references from the perspective of medical staff

Theme 1: The brilliance of the lighthouse

Subtheme 1: Symptom management during the hospitalization period

Quotation 1: “General symptom management. In addition to the role of our nurse as a guide, there is a healthy prescription, that the doctor may be more standardized to implement early interventions with medication, some antiemetic drugs or antidiarrheal agents.” (N11)

Quotation 2: “We are enhancing our focus on symptom management by introducing a standardized no-vomiting ward and utilizing informational boards to promote standardized cancer treatments.” (N17)

Quotation 3: “Because chemotherapy drugs chemotherapy will help educate him, there is some psychological support, and we may communicate with the family, let them give more support… We should not only pay attention to the patient’s psychological counselling; we may also want to pay attention to the psychological counselling of the family members.” (N7)

Subtheme 2: Symptomatic care after discharge

Quotation 4: “We now have a follow-up system, and our department also has a special follow-up mechanism… Just ask about some medication, some adverse reactions, telephone follow-ups, and their own doctors and patients; he has a doctor‒patient WeChat group, and they will also have a reaction in it. For example, if he has any discomfort, he will contact the doctor and the nurses.” (N5)

Quotation 5: “Maybe some of the doctor’s discharge instructions are a little more comprehensive than our nurses, including the time he draws blood and the time he returns to chemotherapy.” (N11)

Quotation 6: “There are many WeChat public accounts in our department. We push some disease-related knowledge, all kinds of… But only knowledge of tweets… There is a medical assistant in our department, some other questions without a chemotherapy plan; she is responsible for the one-to-one communication via WeChat.” (N19)

Theme 2: The fog in the dark night

Subtheme 1: Role overload of medical staff

Quotation 7: “Just like now, we should not only publish papers but also perform clinical work; we need to do research.” (N9)

Quotation 8: “Because the time of the director and the doctor is very limited, there are also contact, but there are more operations, and there may not be timely communication; the current clinical work task is still very heavy.” (N19)

Quotation 9: “Because for the time being, our medical resources in China are not so sufficient, and the clinical work pressure associated with medical care is quite high; now, there is still the pressure of scientific research.” (N16)

Subtheme 2: Information barriers

Quotation 10: “We often have a lot of nurses, when we go to do the mission of the hospital, not all by the same person.” (N12)

Quotation 11: “Of course, some are inevitable. For example, some elderly people face language barriers; they cannot understand what we say, and we can speak only Mandarin, so we have to communicate with their families.” (N17)

Quotation 12: “The education level of patients and their family members affects his communication with doctors and nurses. He has difficulty understanding what doctors and nurses tell him,…. The understanding of their disease is not enough, or the information, maybe there are a lot of us Chinese people like protective treatment, Even some people don’t know they have cancer. They may not be aware of the disease itself…” (N11)

Subtheme 3: Economic constraint symptom management

Quotation 13: “Some patients feel that they don’t want to take that much medicine, that it costs a lot of money, and they will stop it.” (N4)

Quotation 14: “And patients aren’t necessarily willing to pay if you charge them. Yes, you said, I want to get a recipe, you want to let him spend a dozens of dollars; he may think, I can spend dozens of dollars to eat a meal, why should I spend dozens of dollars to give you a recipe home.” (N12)

Quotation 15: “Or feel that some people are afraid of spending money; they do not want that (prescribed medicine)… They may face some economic problems, chemotherapy is uncomfortable, the economy is not good… Otherwise, there is no money, no money, you don’t want to do it (chemotherapy).” (N13)

Subtheme 4: Caregiver escape and life imbalance

Quotation 16: “With the importance of the patient, with the family members, with the degree of support, possible care. Some people are some people for various reasons; children have to go to work or something; he said that he may have a difference in care. For example, with regard to her mother, sometimes she cannot take care of her; after all, she is old.” (N14)

Quotation 17: “For example, many of them are only children; children are very busy, plus the lack of manpower at home; he (the patient) will overcome (symptoms) by himself, which may be a big factor affecting home management.” (N7)

Quotation 18: “It is a more costly one; because they are at home, sometimes when the symptoms are more serious, the family may not have a way that at any time, send someone to take care of, or the family does not care about.” (N2)

Subtheme 5: Difficulties accessing medical services

Quotation 19: “His resources are not enough, he is very remote, he cannot live in… Even if he felt very anxious to know that he wants to seek medical treatment, it is far away from the county seat to the place where it can be solved. Your half-day’s drive will also affect the symptom management.” (N9)

Quotation 20: “In fact, the chemotherapy patients in our department are very fast, and the time they spend in the hospital is very short… His psychological symptoms above, actually, we also do not understand; namely, we do not have a lot of time and energy, unless he has serious mental illness, but generally very few… So, in fact, to him in fact, the psychological contact above is not much.” (N18)

Quotation 21: “Because every time he has to draw blood and prescribe medicine, it may not be very convenient for them to seek medical treatment; it is still a bit like a medical environment. Some people live far away; it may not be convenient for them to draw blood and review.” (N11)

Theme 3: The challenge of the helmsman

Subtheme 1: Multiple symptoms at home

Quotation 22: “Because now the surgery is more than the 3-week plan; the 3-week plan is here, and he only does half a day of treatment, go back to take 14 days of medicine, in fact, his discomfort is at home… At home, we should look at the side effects of our drug and the disease itself, which will affect each other, leading to a lot of symptoms.” (N14)

Quotation 23: “Because we have some of the side effects of chemotherapy, it may appear a few days after returning, especially the first five days of chemotherapy, and it may have some chemotherapy-related side effects… Gastrointestinal reactions and abdominal pain, these symptoms may appear, and some patients with a stoma, if they have stoma problems, they are very troubled.” (N4)

Subtheme 2: Internal conflicts of faith

Quotation 24: “… Therefore, what the doctor thinks is important, but what patients think is not necessarily important. With regard to the patient’s own feeling and the importance of medical judgement, subjective and objective indicators may be combined with symptom management.” (N9)

Quotation 25: “Some of his consciousness, we have explained that we need to draw blood, but he said that there has been such serious anaemia, we cannot draw blood; it is such a situation, in fact, that their whole consciousness is a problem, with regard to their lack of awareness of the disease.” (N17)

Theme 4: Drafting a nautical chart

Subtheme 1: Establishment of a home support system for patients

Quotation 26: “I think that you can make good contact with the community, because many people, like patients who want to draw blood, can go to the community hospital without having to go to our hospital, if you can make better contact in the community. The main thing is education and communication to make it easier for patients.” (N19)

Quotation 27: “That is, he may pay more attention to the doctor, because sometimes the nurse repeatedly stressed that he may not listen carefully or may not pay attention to it, that he may not necessarily have it in mind; it is more possible for the medical care team to unite, to let patients pay attention to these aspects.”(N3)

Quotation 28: “That is to say, in-depth follow-up, maybe with enough human resources, can perform regular family follow-up like the community; it is more recommended to mobilize the resources of community medical treatment, ah.” (N2)

Subtheme 2: Patient education and information provision

Quotation 29: “This kind of home for every family, to ask him to solve this problem. Because many of the patients are either thin or vomiting. Like, this is not what our hospital can solve for him… We must rely on the patient and the family member to cooperate together, you can do it… Diet is one piece, exercise is one piece, and symptom assessment is one piece.” (N12)

Quotation 30: “Food is the life of the people; diet, of course, also includes eating more fresh vegetables, fruits… The effects of drugs, side effects, etc., or some other aspects, such as possible exercise… Some people are very afraid of pain; you do not want to move the people, you have to encourage him; the emotional value is very important.” (N7)

Quotation 31: “you give him a plan, you must urge, track, evaluate, even use some encouraging measures to let him to do it, to see if he has no effect… Still, you can use a few therapies from Chinese medicine, such as Chinese medicine conditioning and so on.” (N18)

Subtheme 3: The construction of the scheme should be based on the “Tri-Dimensional and Tri-Attribute” model

-The “Tri-Dimensional” construction: Scientific, systematic, and individualized

-The"Tri-Attribute” construction: Operability, innovativeness, and sustainability

Quotation 32: “Currently many guidelines feature symptom management, but they focus on a single form of management, not a systematic one… According to his symptoms, you must choose focus symptoms; you cannot build the programme for all systems. For this kind of patient, the most common thing, the most important, is the most troubling for them to intervene; I think that it is still very necessary… I think that it is to have characteristics, if it is innovative, and really can be landed, meaningful, this may be better. It should not be too complex but rather more grounded, and equability is relatively high… It is more important for you to evaluate whether this scheme is effective or not and to determine where its feasibility, its penetrability, its significance are, whether it still has some deficiencies, whether it can be improved in this way.” (N18)

Quotation 33: “How do you guide these, to have individual, targeted care; we listed the things that have we can take, the market we can get to absorb the things… We also said that the movement must be step by step, to see. Of course, when we guide to see is to see the individualized… How to deal with home, to what extent; you must go to seek help, medical treatment, time spent with them to give some doctors and nurses contact information; let him have someone contact for the first time…” (N7)

Quotation 34: “In fact, home care should be based on the needs of patients as the most important guide to care… I think that WeChat is very convenient, both voice and text; it can also have video, and it is actually more convenient than the phone. Now, WeChat is more square than that; this is an app that they have mastered, based on this mature platform; it is better for them, rather than to make them learn to use an app….” (N3)

Quotation 35: “I think that the paper is paper after all; it features a lot of a dynamic feedback, and the whole family together, we should intervene according to the actual situation of the patient; how to make personalized treatment for him, this is the most critical… I suggest that you make these precautions or measures more detailed and more operational. Instead of taking some generic ones such as a literature class before, but you actually you can’t use it… It’s a bit like a critical value, how far do you seek medical attention… Grading management, how is the initial stage of pain, how is the later stage, how to deal with different symptoms…” (N17)

Quotation 36: “A prior precaution before the onset of symptoms or some treatment for the onset of symptoms… On the other hand, you must remind them, for example, through follow-up; it may be this kind of reminder, a kind of urge…Actually I think less a little older they don’t go to turn, suggest that health education lecture hall, you can also qr code, and then his class and code, or WeChat introduced to me, let them open, or TikTok that may brush, open point open see that, short video way and then the kind of public… We have no way to identify one of its core symptoms” (N1)